Editorial

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine. At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration. We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.Who would you blame when that happens? But I have to admit there is some effort, even though the results are but meagre. In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics. This development was reported in i2P under the title “Coles Pharmacy Expansion and the Arid PGA Landscape” In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market. Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Intensive Exposition without crossing over with a supermarket

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing. Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence. It does not take rocket science - you just have to open your eyes. Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

The sure way to drive business away

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently. What an eye and ear opening event that was!Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

‘Marketing Based Medicine’ – how bad is it?

It should be the scandal of the century. It potentially affects the health of almost everyone. Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

Community Pharmacy Research - Are You Involved?

Government funding is always scarce and restricted. If you are ever going to be a recipient of government funds you will need to fortify any application with evidence. From a government perspective, this minimises risk. I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of. But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time. It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

Academics on the payroll: the advertising you don't see

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of SydneyIn the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

I’ve been thinking about admitting wrong.

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

Dispensing errors – a ripple effect of damage

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids. The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”. This same case was reported by A Current Affair (ACA) in its program on Friday 20 June http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

Take a vacation from your vocation

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”Of course you have – because all work and no play aren’t good for anyone. A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. A vacation just means taking a break from your everyday activities. A change of pace. It doesn’t matter where.Everyone needs a vacation to rejuvenate mentally and physically. But did you also know that you can help boost our economy by taking some days off? Call it your personal stimulus package.

Explainer: what is peer review?

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of OxfordWe’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?How does it work?Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.The intention behind this system is to ensure evaluation is not biased.The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

Dentists from the dark side?

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

Planning for Profit in 2015 – Your key to Business Success

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community. ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk. ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

Attracting and Retaining Great People

Welcome to the new financial year in Australia.For many in business the past year has been described as a challenging period.Adjectives are a key feature of the English language. In the business lexicon their use can be, and often is evocative and stimulate creative images. But they can also contribute to inexact, emotional perceptions.Throughout the financial pages of newspapers and business magazines adjectives abound.References to “hot” money draw attention and comment. The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

Updating Your Values - Extending Your Culture

Pharmacy culture is dormant. Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession). Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

Evidence-based medicine is broken. Why we need data and technology to fix it

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines. At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired. All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency. Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines. All else should confine their criticisms to their evidence of the actual evidence published. If there are holes in it then share that evidence with the rest of the world. Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

Laropiprant is the Bad One; Niacin is/was/will always be the Good One

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005). In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual. He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

Culture Drive & Pharmacy Renewal

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life. Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth. All of this is embraced under one word – “culture”. When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder. A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community. ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk. ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

Pharmacy 2014 - Pharmacy Management Conference

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30. Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills. Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

Generation and Application of Community Pharmacy Research

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research. The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire. Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published. I have asked Mark Coleman to follow through, elaborate and comment:

Pain Management and Analgesic Sales

Neil Johnston

Introducing current ideas, perspectives and issues, to the profession of pharmacy

With the changes occurring restricting the sale of analgesic products within pharmacies, there has not been a great deal of discussion as to how best to handle these changes.It has been said that the new processes impact severely on the pharmacist’s workflow.

The analgesic market is a very large one within pharmacy and the ability to lose a major income stream is very real.The following is a press release from the PSA and we have asked Mark Coleman to comment on the various issues:

PHARMACISTS HELPING IN CHRONIC PAIN MANAGEMENT

Pharmacists can play a pivotal role in assisting patients with chronic pain to access support services and also to be a regular point of contact for patients, the Pharmaceutical Society of Australia says.

PSA Queensland Branch President and Member of the National Pain Summit, Dr Lisa Nissen, said pharmacists were caring and informed health-care professionals who were highly trained to assist patients in managing their condition.

“Chronic pain is a significant issue in the community with many patients unable to receive adequate support and care for their condition,” Dr Nissen said.

“Some of this is due to a lack of access to appropriate medical care and pressure on an already overstretched health system.

“However, a significant component of the problem relates to the lack of understanding of the impact of chronic pain on a patient’s health and wellbeing and access to services to support patients in the management of their chronic pain conditions.”

Dr Nissen said the National Pain Summit held earlier in the year proposed a footprint for how the country could move forward.

This included considerations for both the medical profession and the community more widely in better addressing pain management.

Dr Nissen said support services like the Australian Pain Management Association’s Pain Link Helpline (1300 340 357) and Chronic Pain Australia’s National Phone Information and Support line (1800 218 921) provided an important service for not only pain sufferers, but also for the health professionals caring for them.

“We should not undervalue the impact we can make for these chronic pain patients who are often mostly ‘invisible’ within the community,” Dr Nissen said.

“One example is the Home Medicines Review where patients can sit down in their own home with an accredited pharmacist who reviews their medications and helps them to optimise their pain management regime.

“Pharmacists are accessible, trained and ready to assist these patients.

“In conjunction with services like the support line and the help line, the professional services and advice provided by pharmacists can make a real difference in helping chronic pain sufferers manage their condition.”

Mark Coleman comments:

The problems within a pharmacy environment that are created by this issue are considerable.In my mind, there are four streams of patients that exist:

(iii) patients who may have become dependent on analgesics through medical mismanagement;

(iv) patients suffering from neurologic pain.

So the triaging of each patient stream is the first essential plus a plan to be developed to handle each patient stream.

I guess it is time for pharmacies to make an investment decision – and fairly quickly.

Do you want to retain the analgesic market or not?If retention is the aim, then a pharmacist will probably be needed to be recruited to perform all the clinical/counseling roles, including pain management, in addition to the existing number of employees.A business plan needs to be constructed around the provision of such a service to estimate what sort of return an additional pharmacist would generate.

Ideally, this pharmacist would record all the recommendations made from a separate area segregated from the existing work flows.This does not need to be a separate room, but it does need an area with sufficient partitioning to create a level of privacy, particularly in regard to conversations.Patients are more easily enticed into this form of open office rather than an enclosed room.

It may well be possible to manage clinical patients within the dispensing mix without adding additional pharmacist hours, but I think you are only putting off the inevitable.By providing a properly resourced clinical program it will definitely lift medicinal sales and services, including dispensing and increase your market share.

However, the greatest benefit is that it allows a pharmacy practice to expand its range of services and professional product range – and that generates consumer confidence.Allowing closer pharmacist contact with a patient always improves business and goodwill, and allows a pharmacy to generate a professional atmosphere.

Additional investment will also be needed for electronic equipment to record these transactions.Apart from a computer, a simple scanning device is needed to capture Medicare data (or the new patient identifier when it comes along) or a driver's licence, plus be able to read a product bar code.That will quickly and accurately create a primary record.If this record can be uploaded into the dispensary computer at regular intervals, or be able to be networked online with the dispensary computer then you are able to streamline the recording of details without interrupting the dispensing flow.

You may even be able to integrate your own smart card containing the range of details needed to manage your patients with efficiency. Build enough value into your own "patient card" and you will surely begin to concentrate professional business in your pharmacy

The value-adding to this activity could also be increased by integrating preventive medicine programs, including the use of evidence-based nutritional supplements.This could also expand into anti-aging medicine and aged care markets.The anti-ageing segment may require a small compounding area while aged care may need development of a full scale assistive-living program.

And while you are thinking about it an outreach into a “pharmacy-in-the-home” initiative could also extend your reach into home medicines reviews or any variations thereof.

This would require an Internet back up and some form of secure electronic communications system.

Think about the “pharmacy-in-the–home market” – a captive market not dependent on parking areas or competitive shopping malls where you could introduce catalogue campaigns, loyalty incentives etc. to an increasing number of retiring “baby boomers”.Setting up this type of service gives you a “hands-on” approach with your patients that would rival one of your other professional competitors – community nurses. Or by thinking creatively, you create a structure to absorb them.

So far I think we have covered a market that could expand for the next 30-50 years. With the proper infrastructure in place you can leave your competitors at the starting post – and you don’t have to be a warehouse discounter to achieve market dominance.

Think further about the type of pharmacist you may consider employing, and in what form.If the pharmacist is structured as a service company you may have now developed the “arms-length” required for that pharmacist to become a prescriber without a conflict of interest.The type of pharmacists utilised for this service may need to be a mix – senior pharmacists willing to work shorter hours plus recently graduated pharmacists willing to accept mentoring from experienced pharmacists in the clinical field (including hospital pharmacies).

Primary Health Care Organisations are now on the horizon and what better way to link community pharmacy in with this type of facility by utilising a community clinical service.

We have wasted a lot of time and the people charged with developing clinical systems and services have either been “asleep at the wheel” or in some cases have been short-sightedly obstructive.